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Breathing skills for panic attacks, part 1

As I’ve noted before, panic attacks can be pretty awful. What most people don’t know (or don’t believe) is that panic attacks are not actually harmful. This is why the first stage of counseling or therapy is focused on education about what panic attacks are, what can cause them, what they do and what they don’t do.

About 50-60% of people overbreathe, or hyperventilate when they panic. Overbreathing may produce the initial physical feeling that frightens you and leads to a panic attack, or having a panic attack may lead to overbreathing. Although symptoms of overbreathing can be very intense, they are not dangerous. Breathing skills can help you deal directly with the physical symptoms and situations that you fear or avoid.

This is just a blog article, so don’t expect the same depth of discussion as would occur in actual therapy with me, but some basic skills are easy to learn and very helpful. Correct breathing is indispensable, particularly breathing from the diaphragm. This initial skill is not designed to control or prevent feelings of fear and anxiety; it’s intended to help you face feelings of fear and anxiety and the situations in which they occur. Do this exercise for 10 minutes, twice per day. Set a timer if you like so you don’t need to watch the clock, but do it regularly.

First place one hand over your chest, and another over your stomach, the little finger about an inch above the belly. Breathing from the diaphragm means when you inhale your stomach should expand, and your chest should not move. This is crucial, because when you are panicking it’s typically the opposite: our chest moves rapidly and our stomach isn’t. This type of breathing can actually contribute to more anxiety. If breathing from the diaphragm feels funny at first, remember you are getting enough oxygen and the feeling will decrease the more you practice.

Second, just breathe normally. Don’t take in too much air, don’t try to slow your breathing, and keep it smooth. It doesn’t matter whether you breathe through your nose or mouth, as long as you breathe smoothly. Practice until this comes fairly easily.

The third step introduces a small focus skill, it involves counting every time you breath in, and thinking the word “relax” as you breathe out. When you breathe in, think “one” to yourself, and when you breathe out think the word “relax.” Think “two” on your next inhale, and “relax” again on the exhale. Continue this until you get to 10, then go back to one.

It’s important to remember to focus only on your breathing and the words. This can be difficult, so don’t worry if you’re not doing it perfectly–you may never do it perfectly, and you don’t have to be perfect. Don’t get angry or give up, just let the thoughts that arise pass through your mind, then bring your attention back to the breathing, the numbers and the words.

For now, don’t use this kind of breathing at times of anxiety, because trying something that is only partially developed can be more frustrating and anxiety-producing than not trying it at all. For right now this exercise should only be done in a quiet, comfortable environment. If you want to get the most out of this, use this breathing skills record to record your level of concentration on the breathing and counting, and your success with using your diaphragm muscle. It should last you about a week.

My next blog entry will cover part 2, but don’t go there until you have completed at least seven days of this exercise, so you get it down. Please feel free to contact me if you have any questions. I also gratefully acknowledge Dr. Barlow’s work on panic attacks and anxiety, from which I draw my concepts and exercises.